Joint pathology: rheumatoid arthritis: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Joint pathology: rheumatoid arthritis

Sample item

A 45-year-old woman has symmetrical swelling of the metacarpophalangeal joints with morning stiffness lasting more than an hour. Which tissue is directly responsible for erosion of articular cartilage and bone in her disease?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Synovial pannus of inflamed granulation tissue

In rheumatoid arthritis, T-cell and cytokine-driven synovitis leads to hyperplastic synovium with neovascularisation, lymphocytes and plasma cells. This pannus releases TNF, IL-1 and matrix metalloproteinases that erode cartilage and juxta-articular bone. TNF inhibitors reduce this process.

Option by option

  • A. Synovial pannus of inflamed granulation tissue (correct)

    Correct. Pannus invades and erodes cartilage and bone.

  • B. Marginal osteophyte

    Osteophytes are reactive new bone in osteoarthritis and do not erode bone.

  • C. Monosodium urate tophus

    Urate tophi are deposits of gout and not a feature of symmetrical inflammatory arthritis.

  • D. Calcium pyrophosphate crystal deposits

    Calcium pyrophosphate crystals cause pseudogout with chondrocalcinosis, not symmetric erosive disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, Synovial pannus of inflamed granulation tissue. In rheumatoid arthritis, T-cell and cytokine-driven synovitis leads to hyperplastic synovium with neovascularisation, lymphocytes and plasma cells.

Why is "Marginal osteophyte" not the answer?

Osteophytes are reactive new bone in osteoarthritis and do not erode bone.

Why is "Monosodium urate tophus" not the answer?

Urate tophi are deposits of gout and not a feature of symmetrical inflammatory arthritis.

Why is "Calcium pyrophosphate crystal deposits" not the answer?

Calcium pyrophosphate crystals cause pseudogout with chondrocalcinosis, not symmetric erosive disease.

What concept does this question test?

It tests Joint pathology: rheumatoid arthritis in Pathology. This pannus releases TNF, IL-1 and matrix metalloproteinases that erode cartilage and juxta-articular bone. TNF inhibitors reduce this process.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Joint pathology: rheumatoid arthritis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.